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Introduction and importance In this paper, we report an unusual case of a closed-loop bowel obstruction secondary to a double gallstone ileus. This type of pathology constitutes an emergency, and requires prompt surgical intervention to prevent further complications. Presentation of case The patient was a 90-year-old female who came to our emergency room with a clinical picture compatible with an acute abdomen. Imaging tests performed included a plain radiograph and abdominal CT-scan, which confirmed the diagnosis. The patient was then transferred to the operating room, and an open double enterolithotomy was performed, extracting two cylindrical gallstones with a diameter of over 2.5 cm. No treatment was given for either the gallbladder nor the biliary-enteric fistula due to the patient's physical status. Clinical discussion Gallstone ileus is a rare entity, but must be taken into consideration when a patient with an abdominal obstruction arrives to the emergency department, especially when signs such as pneumobilia or visualization of the stones are detected by imaging tests. Early surgical intervention is required to avoid complications. However, addressing the biliary-enteric fistula at the same time is a sensitive procedure that may not be advisable, depending on the status of the patient. This report includes a bibliographic review of existing cases of gallstone ileus and the specifics of its diagnosis and management. Conclusion This pathology can lead to serious complications if not managed properly. Prompt diagnosis and surgical intervention are essential to avoid complications such as intestinal gangrene and perforation. Inspecting the entire intestine during surgery is crucial for removing any additional gallstones that may be present to prevent the reappearance of symptoms., Highlights • Gallstone ileus is an uncommon condition which requires an emergency surgical approach. • The entire intestine should be inspected during surgery. • A prompt diagnosis can be achieved via CT-scan. • Management of gallbladder and biliary-enteric fistula is controversial. • Enterolithotomy is the procedure of choice for relieving intestinal obstruction.

Highlights • De Garengeot’s hernias constitute an extremely rare condition associated with emergency surgery. • Suspicion and experience are crucial for correct management, as no therapeutic or diagnosis consensus has been reached. • A single surgical procedure can be performed to treat both pathologies; incarcerated hernia and strangulated appendix. • An open preperitoneal approach permits correct visualization of the sac contents and permits appendectomy and hernia repair. • When a complication is found, such as local perforation or abscess, a two-step abdominal wall repair should be considered., Introduction De Garengeot’s Hernia is a rare type of femoral hernia in which the appendix is located inside the herniated sac. Diagnosis of the condition is challenging and its treatment must be performed without delay. Presentation of case We present the case of a 75-year-old patient with a femoral hernia in which an appendix with signs of inflammation was found. An appendectomy followed by hernia repair was performed under an open preperitoneal approach according to Nyhus technique. The patient did not present any complications and was discharged on the second postoperative day. Discussion This type of hernia is often unexpected and its preoperative diagnosis is difficult to perform. In most cases the clinical picture is indistinguishable from a common incarcerated hernia. Contrast-enhanced CT is the most useful complementary test, although it is not as accurate as desirable, so the diagnosis is frequently found intraoperatively. There is a wide variety of surgical options and there is no consensus on the most appropriate one. The preperitoneal approach enables the performance of an appendectomy and subsequent hernia reparation. The use of prosthesis should be considered if there are no signs of perforation or abscess. Conclusion De Garengeot’s hernia is a very rare entity. The diagnosis and subsequent surgical treatment must be early to prevent the disease progression. The preperitoneal approach should be considered as the first choice technique, as it allows the exploration of the herniated sac and the performance of surgical procedures on its content.

Resumen Introduccion Las neoplasias quisticas pancreaticas representan un grupo heterogeneo de enfermedades, donde la neoplasia mucinosa papilar intraductal esta alcanzando protagonismo. El objetivo del estudio es revisar nuestra serie de neoplasias quisticas pancreaticas intervenidas y valorar la concordancia con las recomendaciones de Fukuoka. Metodos Revisamos de forma retrospectiva nuestra experiencia analizando los datos clinicos y radiologicos, la indicacion quirurgica y el estudio histologico de los 11 pacientes intervenidos en nuestro centro desde julio de 2011 a julio de 2015 por esta enfermedad, con el objetivo de valorar la concordancia con los consensos actuales. Resultados En nuestra serie la mayoria de los casos (7/11) presentaban sintomas al diagnostico. El diagnostico preoperatorio se alcanzo en 10 pacientes mediante radiologia y/o ecoendoscopia. Las indicaciones quirurgicas fueron presencia de sintomas, datos radiologicos de sospecha de malignidad y neoplasia de rama secundaria asintomatica mayor a 30 mm. Los hallazgos en estudio histologico fueron de malignidad en 6/11 (2 neoplasia invasiva, 4 displasia de alto grado), displasia moderada en 2/11, displasia de bajo grado en 2/11 y ausencia de displasia en un paciente. Conclusiones La indicacion quirurgica de las neoplasias mucinosas papilares intraductales de pancreas depende de los sintomas asociados, dimensiones, localizacion, riesgo y sospecha de malignidad.

Cystic pancreatic neoplasms are a heterogeneous group of pathology, and intraductal papillary mucinous neoplasia is becoming more common. The aim of this study is to review our series of cystic pancreatic neoplasms that underwent surgery and to evaluate the similarities with Fukuoka recommendations.Retrospective review of our experience analyzing clinical and radiological data, indication for surgery and pathology study of 11 patients operated on in our centre from july 2011 to july 2015, aiming to evaluate the degree of agreement with the current consensus.In our series the majority of cases (7/11) had symptoms at diagnosis. Preoperative diagnosis was achieved in 10 patients using radiology and/or endoscopy. Indications for surgery were the presence of symptoms, radiological data suspicious of malignancy, and secondary branch neoplasia over 30mm. Pathological findings were malignancy in 6/11 cases (2 invasive neoplasia, 4 high grade dysplasia), moderate dysplasia in 2/11, low-grade dysplasia in 2/11 and no dysplasia in one patient.Surgical indication of intraductal mucinous pancreatic neoplasms depends on the associated symptoms, size, location, risk and suspicion of malignancy.

Spontaneous pneumoperitoneum is a common finding in patients with abdominal disorders. In 90% of cases, this entity results from hollow viscera perforation. Rupture of a pyogenic liver abscess is an infrequent complication occurring in 5 to 15% of cases. Pneumoperitoneum secondary to intraperitoneal rupture of an abscess is extremely rare and very few cases have been reported in the literature. Given its clinical interest, we report a case of pneumoperitoneum due to spontaneous rupture of a gas-containing pyogenic liver abscess.

Spontaneous pneumoperitoneum is a common finding in patients with abdominal disorders. In 90% of cases, this entity results from hollow viscera perforation. Rupture of a pyogenic liver abscess is an infrequent complication occurring in 5 to 15% of cases. Pneumoperitoneum secondary to intraperitoneal rupture of an abscess is extremely rare and very few cases have been reported in the literature. Given its clinical interest, we report a case of pneumoperitoneum due to spontaneous rupture of a gas-containing pyogenic liver abscess.